- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20.02 / $68.28 / $107.17
| Facility | | $20.02 | $68.28 | $107.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.20 / $3.84 / $5.12
| Professional | | $3.20 | $3.84 | $5.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.66 / $3.76 / $11.78
| Facility | | $3.66 | $3.76 | $11.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.65 / $4.96 / $6.20
| Professional | | $2.65 | $4.96 | $6.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4.26 / $4.91 / $19.23
| Facility | | $4.26 | $4.91 | $19.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $3.27 / $3.53 / $4.79
| Professional | | $3.27 | $3.53 | $4.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1.79 / $1.79 / $2.56
| Professional | | $1.79 | $1.79 | $2.56 |